MEDICARE: AMY ELAINE TUCKER LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	60635494	WA

General Provider Information

NPI Number	:	1437510732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELAINE TUCKER LMP

Provider Business Mailing Address
First Line	:	1900 W NICKERSON ST
Second Line	:	SUITE 116-31
City	:	SEATTLE
State	:	WA
Zip	:	98119-1661
Country	:	US
Telephone Number	:	661-331-0470
Fax Number	:

Provider Business Practice Location Address
First Line	:	661 W NICKERSON ST
Second Line	:	#3
City	:	SEATTLE
State	:	WA
Zip	:	98119-1540
Country	:	US
Telephone Number	:	661-331-0470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/14/2016

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Directions to “ AMY ELAINE TUCKER LMP” Practice Location

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